A&A practice
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Case Reports
Bilateral Erector Spinae Plane Block for Surgery on the Posterior Aspect of the Neck: A Case Report.
The erector spinae plane block is an interfascial plane block whereby local anesthetic is injected within the plane deep to the erector spinae muscle and superficial to the transverse process. To date, it has been used to provide analgesia in thoracic, abdominal, and lumbar regions. We present the first reported case of bilateral erector spinae plane block being used to provide surgical anesthesia in the cervical region.
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Although rare, cannot intubate and cannot oxygenate situations are challenging acute events. The development of management algorithms, standardized equipment provisions, and appropriate clinical training in the application of front-of-neck access techniques are necessary to optimize procedural success to ensure adequate oxygenation. ⋯ With proper implementation, this unique process aligning the cannula cricothyroidotomy and scalpel bougie as primary and secondary techniques, respectively, can potentially optimize procedural success. This algorithmic approach is trained routinely among our anesthesia providers, while the equipment is standardized throughout our anesthetizing locations.
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We present a case of a 41-year-old man who suffered cardiac arrest after induction of general anesthesia for an ambulatory ophthalmologic procedure. In this report, we highlight the use of focused transthoracic echocardiography by the anesthesia team to guide a prolonged resuscitation. Emergency room and critical care physicians have described the use of focused echocardiography to aid in diagnosing correctible causes of cardiac arrest, predicting outcomes, and in decision making regarding termination of resuscitation. We discuss benefits and barriers to anesthesiologists incorporating focused cardiac ultrasound into the perioperative arena.
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A healthy, 34-year-old primigravida at 41 weeks gestational age presented for cesarean delivery due to a category 2 fetal heart tracing remote from delivery. After completion of the surgery under epidural anesthesia, bilateral quadratus lumborum blocks were performed for postoperative pain. ⋯ These symptoms resolved within 24 hours. Considering the time course of her symptoms, we believe that the quadratus lumborum block was the likely culprit.
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A patient presented with a stab injury caused by a knife penetrating the orbital floor and maxillary sinus along the skull base with the tip situated adjacent to the left internal carotid artery. A flexible fiberoptic bronchoscope loaded with an endotracheal tube was initially positioned superior to the vocal cords and advanced into the trachea immediately following induction. The blade was removed after occluding endovascular balloons were positioned distal and proximal to the potential internal carotid artery injury site. Therefore, contralateral nasal fiberoptic intubation might be safely performed in patients with unilateral maxillofacial trauma, no intracranial penetration, and minimal bleeding.